Prior Authorization & Benefits Verification Specialist

Thomas Jefferson University & Jefferson Health; Pennsylvania; On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life and AD&D insurance

Short- and long-term disability

Flexible spending accounts

Retirement plans

Tuition assistance

Job summary

Thomas Jefferson University & Jefferson Health is seeking a detail-oriented Insurance Verification Specialist to coordinate benefits verification and secure prior authorizations for surgical procedures, tests, medications, and referrals. You will interpret payer requirements and support consistent, timely reimbursement across payer and patient channels.

The role requires experience with EHRs, multiple payers, and medical necessity standards.

Qualifications

• Minimum high school diploma or GED required.
• At least 1 year of healthcare insurance verification and prior authorization experience.
• Experience with multiple payers and understanding medical necessity requirements.
• Familiarity with CPT, ICD-10 and HCPCS coding as it relates to authorizations.
• Knowledge of patient rights and HIPAA regulations.

Responsibilities

• Collaborates with physicians and provider office staff to obtain appropriate authorizations.
• Performs medical necessity reviews to ensure payer requirements are met.
• Obtain authorizations in compliance with network policies and communicate exceptions.
• Interface with insurance companies to verify coverage and precertification.
• Review and verify additional clinical information and referrals as needed.
• Monitor work queues and patient schedules to ensure accurate authorizations before visits.
• Maintain compliance with metrics for accounts registered versus scheduled procedures.
• Calculate estimated patient financial responsibility using verification and payer contracts.

Skills

Insurance verification

Prior authorization

EHR experience

Medical necessity understanding

Communication skills

Education

High School Diploma/GED

Associate’s Degree in healthcare administration

Tools

EHR systems

Insurance portals

Job description

Thomas Jefferson University & Jefferson Health is seeking a detail-oriented Insurance Verification Specialist to coordinate benefits verification and secure prior authorizations for surgical procedures, tests, medications, and referrals. You will interpret payer requirements and support consistent, timely reimbursement across payer and patient channels.

The role requires experience with EHRs, multiple payers, and medical necessity standards.